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Washington rates for HCPCS B4160

Enternal Formula For Pediatrics Nutritionally Complete Calorically Dense

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.34 / $0.86
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $2.70 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.42
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.80 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.86 / $2.70